MRI评估宫颈癌病变范围的临床分析

目的评价磁共振成像对宫颈癌分期的价值。方法对33例宫颈癌患者在手术前进行磁共振成像(MRI)检查,依临床分期制定治疗计划。以术后病理诊断为金标准,将临床、磁共振成像分期结果中癌浸润的部位和范围、淋巴结转移,尤其对宫旁浸润采用患者自身对照法与手术病理所见进行对比,评价宫颈癌分期。结果MRI对宫旁浸润判断的准确度为94%,特异度为96%,敏感度为90%。MRI对宫颈癌总的分期预测的准确性为75.7%。在局限性和宫旁浸润的区分中MRI有着94%的准确性。结论MRI在宫颈癌中对区分局限性和浸润性病灶有着较高的准确性。引入MRI技术于临床,有利于治疗计划的制定,应成为宫颈癌术前常规的影像检查方法。     

核磁共振联合阴道彩超评估早期子宫颈癌病情的价值初探

目的:探讨核磁共振成像(MRI)联合阴道彩色多普勒超声(TVUS)预测早期宫颈癌预后高危因素的价值。方法:选择2008年9月至2013年1月在北京大学人民医院住院的临床分期为ⅠB和ⅡA期、术前未接受其他治疗并具有完整影像学检查资料的78例患者,患者术前均行核磁共振常规及加权成像(MRI+DWI)和TVUS检查,回顾分析影像学检查结果与术后病理的关系。结果:MRI、TVUS、MRI联合TVUS判断肿瘤直径、阴道浸润、宫旁组织受侵及淋巴结转移与术后病理的一致性均较高,均无统计学差异(P均≥0.05);判断宫颈间质浸润深度与术后病理的一致性较低,具有统计学差异(MRI组:P=0.007;TVUS组:P=0.010;MRI联合TVUS组:P=0.002);预测肿瘤直径、宫颈间质浸润、阴道浸润、宫旁浸润、淋巴结受累中的准确率:MRI分别为81.8%、73.7%、84.6%、94.9%、78.2%;TVUS分别为66.7%、51.3%、78.2%、96.1%、82.0%;MRI联合TVUS分别为84.4%、78.2%、89.7%、97.4%、92.3%。结论:术前MRI联合TVUS检查对预测早期宫颈癌可能出现的影响预后的高危因素有重要价值,可提高术前病情评估的准确度,为选择最佳治疗方案提供参考。     

应用MRI评价宫颈癌分期的临床研究

目的探讨应用磁共振成像(MRI)指导宫颈癌分期的价值。方法对64例宫颈癌患者在手术前行MRI,均依临床分期结果制定治疗计划。以术后病理诊断为金标准,采用病例自身对照法将临床、MRI分期中癌浸润的部位和范围、淋巴结转移,尤其是宫旁浸润情况与手术病理所见对比,评价宫颈癌分期。结果MRI对浸润性宫颈癌判断的准确率为93.7%,特异性为95.7%,敏感性为88.9%。MRI预测宫颈癌总的分期的准确率为75.1%。在区分局限性和宫旁浸润中MRI的准确率为93.7%。MRI对宫颈癌侵犯部位和范围判断的准确率达88.5%。MRI对淋巴结转移预测的准确性为90.6%。结论MRI可多方位成像清楚显示宫颈肿瘤病变范围,MRI对区分局限性和浸润性病灶、淋巴结转移有着较高的准确性。临床引入MRI技术,有利于合理制定治疗计划,应成为宫颈癌术前常规的影像检查方法。     

子宫颈癌术前和术后诊断结果的临床对比分析

目的：探讨子宫颈癌术前临床检查与术后病理诊断结果的差异。方法：回顾性分析511例因子宫颈浸润癌而行广泛性子宫切除+盆腔淋巴结切除术患者的术前妇科检查、术中肉眼观察及术后病理检查情况,并对结果进行对比。结果：术前因妇科检查骶主韧带增厚增粗而诊断为Ⅱb期142例,而术后病理确诊者23例,阳性符合率为16.20%;术前妇科检查骶、主韧带阴性187例,但术后病理检查有浸润7例,阴性符合率96.26%;术前认为阴道穹窿阴性但术后病理阳性31例,阴性的符合率92.87%;术前考虑阴道穹窿受累但术后病理为阴性17例,阳性的符合率77.63%;术中因淋巴结肿大、质脆、粘连而诊断有淋巴结转移共299个,术后病理证实有转移的229个,阳性符合率76.59%,而认为淋巴结正常但病理诊断有转移54个。 结论：宫颈癌的临床分期与术后病理结果确实存在差异,尤其体现在宫旁的诊断上。妇科检查与病理检查对宫旁的诊断阴性符合率较高,而阳性符合率低;对阴道穹窿的诊断阴性符合率亦较高,阳性符合率稍低;肉眼观察淋巴结有无转移是不够准确的。     

淋巴脉管间隙浸润对早期宫颈癌预后的影响分析

目的探讨淋巴脉管间隙浸润(LVSI)对早期宫颈癌预后的影响。方法回顾性分析2009年1月至2015年12月郑州大学第二附属医院经手术治疗的470例ⅠA2~ⅡA2期宫颈癌,分为LVSI阳性组和LVSI阴性组,比较两组间的临床病理特征,分析LVSI对早期宫颈癌预后的影响。结果 22例失访,有预后资料者共448例。单因素分析显示LVSI与组织学分级、宫颈间质浸润、宫旁浸润、阴道穹窿浸润、淋巴结转移有关,Logistic回归分析显示LVSI阳性与组织学低分化、深间质浸润、宫旁转移和淋巴结转移相关。55例复发病例中LVSI阳性21例(38.2%),393例未复发病例中LVSI阳性63例(16.0%)。50例死亡病例中LVSI阳性17例(34.0%),398例存活病例中LVSI阳性67例(16.8%),两组间差异均有统计学意义(Ρ=0.000,Ρ=0.003)。全组5年总生存率、无瘤生存率为87.9%、86.8%。单因素分析显示临床分期、组织学分级、宫颈间质浸润、宫旁浸润、阴道穹窿浸润、LVSI、淋巴结转移、LVSI和淋巴结转移和术后治疗影响5年总生存时间(OS)和无瘤生存时间(DFS)。COX多因素分析显示,宫颈间质浸润、组织学分级、淋巴结转移是5年OS、DFS的独立预后因素,阴道穹窿受侵是5年OS的独立预后因素,LVSI是5年DFS的独立预后因素。结论 LVSI与多种不良预后因素相关,是早期宫颈癌复发和转移的危险因素,LVSI是5年无瘤生存的独立影响因素,尚不能确定LVSI是早期宫颈癌5年总生存的独立影响因素。     

磁共振成像在子宫内膜癌FIGO2009新分期改动中的应用及误判分析

目的 评估增强磁共振成像（MRI）对子宫内膜癌肌层和宫颈浸润及盆腔淋巴结转移的诊断价值并分析误判的相关因素。方法 收集2009年3月至2013年3月天津医科大学总医院妇科收治的167例子宫内膜癌患者临床、增强MRI及病理资料进行回顾,将MRI分期与病理分期结果进行对照,并对肌层和宫颈浸润深度及淋巴结转移误判的相关因素进行分析。结果 （1）MRI诊断准确率随期别升高而降低,随子宫内膜样腺癌分化程度的降低而降低,差异有统计学意义（P<0.05）;MRI诊断子宫内膜样腺癌和特殊病理类型患者的准确率为79.74%和64.29%,差异有统计学意义(P<0.05)。（2）MRI诊断肿瘤浅肌层浸润的敏感度、特异度、准确率、阳性预测值（PPV）、阴性预测值（NPV）及与病理结果一致性的手捣直鹞?91.79%、90.91%、91.62%、97.62%、73.17%和0.758;深肌层浸润率分别为90.91%、91.79%、91.62%、73.17%、97.62%和0.758;宫颈浸润率分别为84.21%、95.95%、94.61%、72.73%、97.93%和0.750;盆腔淋巴结转移率分别为45.00%、91.16%、85.63%、40.91%、92.41%和0.347。（3）MRI错误评估肌层浸润、宫颈浸润及盆腔淋巴结转移,与患者分娩次数少、合并肌瘤、宫角部位病变、深肌层浸润、肿瘤体积大（包括肿瘤占宫腔面积≥1/2及肿瘤最大径较大）、子宫内膜样腺癌低分化及特殊病理类型正相关（P<0.05）。结论 增强MRI对术前子宫内膜癌深肌层浸润、宫颈浸润和盆腔淋巴结转移评估具有较高的准确率和阴性预测值。当患者合并肌瘤、宫角部位病变、肿瘤体积较大、特殊病理类型和子宫内膜样腺癌低分化等因素时较易误诊。     

宫颈癌患者脉管内癌栓浸润与其他临床病理因素的相关性分析

目的：分析宫颈脉管内癌栓浸润（lymph-vascular space invasion,LVSI）与宫颈癌其他临床病理因素的关系,为指导宫颈癌治疗提供依据。方法：回顾性分析2003年4月—2013年5月上海市第一妇婴保健院收治的462例宫颈癌患者的临床及病理资料,其中LVSI阳性者185例（40%）,阴性者277例（60%）,对LVSI与肿瘤分期、淋巴结转移及其他临床、病理因素的关系进行相关性分析。结果：单因素分析显示宫颈癌患者LVSI的发生与肿瘤分期、肿瘤大小、浸润深度、淋巴结转移、是否术前经过新辅助治疗有关,而与采用何种新辅助治疗方法无关。LVSI与宫颈癌的其他5项高危因素,即组织病理学类型、间质浸润深度、肿瘤体积、宫旁浸润、淋巴结转移有关;且合并的高危因素越多,LVSI的发生率越高。结论：LVSI与其他病理高危因素密切相关,可能更早地提示淋巴结转移等其他高危因素的潜在风险,对指导宫颈癌的治疗意义重大。     

磁共振成像与术中病灶探查诊断子宫内膜癌肌层浸润及盆腹腔淋巴结转移临床价值研究

目的探讨磁共振成像(MRI)和术中病灶探查在子宫内膜癌肌层浸润及盆腹腔淋巴结转移诊断中的临床应用价值。方法回顾性分析上海交通大学附属第九人民医院2010年1月至2014年3月收治的33例行全子宫+双侧附件切除术+盆腔及腹主动脉旁淋巴清扫术的子宫内膜癌患者临床资料,以手术病理诊断为标准,比较术前MRI检查、术中病灶探查在诊断肿瘤侵犯子宫肌层深度和淋巴结转移的符合率。结果 MRI检查发现有肌层浸润33例,其中浅肌层浸润8例,深肌层浸润25例;术中剖视子宫标本发现有肌层浸润33例,其中浅肌层浸润6例,深肌层浸润27例。术后病理结果浅肌层浸润6例,深肌层浸润27例。提示MRI诊断浅肌层浸润敏感度100.00%,特异度92.59%。诊断深肌层浸润敏感度92.59%,特异度100.00%;术中病灶剖视诊断深浅肌层浸润敏感度和特异度均为100.00%。33例患者中经病理组织学确诊,8例患者出现淋巴转移,其中仅有盆腔淋巴结转移4例,盆腔及腹主动脉旁淋巴结转移2例,仅有腹主动脉旁淋巴结转移2例;33例患者术前MRI检查提示2例淋巴结转移,漏诊6例,MRI诊断淋巴结转移的敏感度25%;病灶探查发现4例盆腔淋巴结肿大(病理证实2例阳性,2例阴性),2例腹主动脉旁淋巴结肿大(1例阳性,1例阴性)。3例患者因淋巴结转移分期升级,术后需要辅以化疗和(或)放疗。结论子宫内膜癌患者术前MRI检查对判断肌层浸润深度准确率较高,手术中子宫标本的剖视与病理组织学检查相同,具有重要价值;而MRI检查和术中淋巴结探查对判断子宫内膜癌患者淋巴结转移的意义不大。盆腔及腹主动脉旁(至肾静脉水平)淋巴清扫可以使手术病理分期更准确,为患者术后提供更合理的治疗指导。     

子宫颈癌术前和术后病理诊断结果的对照分析

目的探讨针对子宫颈癌患者,对比术前诊断与术后病理诊断结果差异。方法选择我院2012年10月~2015年9月收拾的子宫颈癌患者80例,所有患者临床选择子宫切除术以及盆腔淋巴结清除术进行治疗,针对患者术前以及术后病理检查结果进行观察对比。结果对患者实施术前诊断后发现,无阴道穹窿受侵患者54例,完成手术后病理诊断为阴道穹窿表现为阴性患者50例,诊断符合率为92.59%;术前诊断患者存在宫旁浸润最终诊断为子宫颈癌ⅡB患者5例,完成手术后经过病理诊断结果为2例,诊断符合率为40.00%;术前诊断无宫旁浸润患者76例,术后病理诊断结果为71例,诊断符合率为93.42%;手术过程中诊断淋巴结表现为阳性83个,术后病理诊断结果表明转移的淋巴结66个,诊断符合率为79.52%。结论针对子宫颈癌患者,术前诊断与术后病理诊断一定程度的差异,特别针对宫旁阳性临床诊断符合率较低,对此需要研究有效方法将子宫颈癌临床诊断准确率提高。     

宫颈癌术后复发60例临床分析

目的　通过对子宫颈癌术后复发原因的分析,旨在提高宫颈癌病人手术成功率。方法　对 1990年 1月至 2000年 12月四川省肿瘤医院术后复发的子宫颈癌 60例进行回顾性分析,了解子宫颈癌术后复发部位、复发时间及术后复发与肿瘤病理和临床治疗方法的关系。结果　60例术后复发患者中,盆腔复发和远处转移分别占 80.0%、8.3%,同时有盆腔复发和远处转移占 11.7%。最常见的复发部位是盆腔 (阴道及宫旁 ),淋巴结转移者与脉管瘤栓、切缘阳性、宫旁或盆腔脏器受侵者的盆腔复发率分别为 72.8%、100.0%,远处转移率分别为54.6%、7.1%。结论　子宫颈癌术后以盆腔复发最为常见,有盆腔淋巴结脉管内转移者易出现远处转移。要提高手术成功率必须做到术前诊断与分期准确、严格掌握手术适应证、进行规范的手术操作以及必要的术前综合治疗。     

The performance of magnetic resonance imaging in early cervical carcinoma: a long-term experience

We report our long-term experience of performance of magnetic resonance imaging (MRI) in localizing cervical tumor, assessing tumor size, staging, and lymph node infiltration in patients with early cervical cancer. MRI of 150 patients with early carcinoma between 1995-2005 was retrospectively reviewed. Tumor location, size, tumor distance from internal os, parametrial invasion, myometrial invasion, lymph node size, and location were documented. All patients underwent surgery, pelvic lymphadenectomy, and histological correlation of MRI findings. For staging, MRI and histopathology had kappa value of 0.89. For parametrial invasion, MRI had specificity, negative predictive value (NPV) of 97% and 100%, respectively. For tumor size, MRI and histology had mean difference of -0.9 mm with 95% limits of agreement between -12.6 to +13 mm. In tumors greater than 10 mm, mean difference was 0.3 mm and limits of agreement were -7.5 to +7.9 mm. For internal os involvement sensitivity, specificity, positive predictive value (PPV) and NPV were 90%, 98%, 86%, 98%. respectively. For myometrial invasion sensitivity, specificity, NPV, and PPV were 100%, 99%, 88%, 100%, respectively. Incidence of nodal metastases was 2.9%. On a per-patient basis, sensitivity, specificity for nodal involvement was 37% and 92% and on node-by-node basis, sensitivity and specificity of MRI was 27% and 99%, respectively. Our study confirms MRI is highly accurate in localizing cervical tumor, excluding parametrial invasion, confirming myometrial and internal os invasion. MRI is therefore useful in selecting patients for surgery and mandatory in patients for fertility-preserving surgery. Using accepted size criteria for nodal involvement, MRI is insensitive and currently will not avoid need for pelvic lymphadenectomy.     

Magnetic resonance imaging in the preoperative staging of endometrial carcinoma

PURPOSE OF INVESTIGATION: Magnetic resonance imaging (MRI) has emerged as an important imaging modality in the evaluation of the extension of endometrial carcinoma which is essential in planning treatment and predicting prognosis. This study aimed to assess the value of MRI in the preoperative staging of endometrial carcinoma. METHODS: We included in this study 162 patients with a histological diagnosis of endometrial carcinoma who underwent MRI pelvic imaging and surgical staging. MRI images were compared with pathological findings to measure MRI's sensitivity, specificity, positive and negative predictive values and diagnostic accuracy in what concerns myometrial, cervical and lymph node invasion. RESULTS: MRI differentiation of deep myometrial invasion from superficial disease agreed with pathological findings in 77% of cases, with a sensitivity of 83%, a specificity of 72% and a diagnostic accuracy of 77%. Concerning cervical invasion, MRI had a sensitivity, specificity and diagnostic accuracy of 42%, 92%, 81% respectively. In assessing lymph node invasion, MRI presented a sensitivity of just 17%, a specificity of 99% and a diagnostic accuracy of 89%. CONCLUSION: Our study confirmed the high accuracy of MRI imaging in assessing myometrial and cervical invasion in endometrial carcinoma. When evaluating lymph node invasion, micrometastases are responsible for the low sensitivy of MRI.     

The value of ultrasonography in preoperative assessment of selected prognostic factors in endometrial cancer

OBJECTIVE: To determine the efficiency of transabdominal and transvaginal ultrasonography (TAS and TVS) in the assessment of myometrial invasion, cervical involvement, pelvic lymph nodes, adnexal and omental metastases (preoperative staging) of endometrial cancer. METHODS: Transabdominal and transvaginal 2D, ultrasound were performed on 90 women to classify myometrial invasion, cervical involvement, pelvic lymph nodes and adnexal metastases in endometrial cancer. According to this 13 type E (invasion involving the endometrium), 41 type S (superficial, of less than 50% of myometrial infiltration), 36 type D (deep infiltration) and 22 cervical involvement were identified. There were 15 G1, 60 G2 and 15 G3 cases. Adnexal, omental and lymph-node metastases were found in 11, two and 15 cases, respectively. Endometrial cancer was diagnosed on the basis of dilatation and curettage. The degree of invasion was evaluated preoperatively. Ultrasonographic findings were compared to surgical staging and histopathology of the surgical specimen. RESULTS: The median age of the 90 women was 63.3 +/- 12.3 years (range 32 to 86 years). The median thickness of malignant endometrium was 19.5 +/- 9.6 (range 7 to 54 mm). In type E the median thickness was 11.76 +/- 4.2, in type S 17.3 +/- 7.6, in type D 24.8 +/- 9.8 and in cases with cervical involvement 23.2 +/- 11 mm. Myometrial invasion evaluated by TVS was accurate in 76 of 90 cases (accuracy 84.4%). In type E sensitivity was 92.3%, specificity 87.0%, positive and negative predictive value, respectively, 63.1% and 98.6%. In type S these values were respectively: 78.0%, 93.9%, 91.4%, 80.0% and in type D--88.9%, 92.6%, 88.9% and 100.0%. Tumor extension to the cervix was properly assessed in 19 of 22 women in which it was present (sensitivity 86.4%, specificity 85.3%, positive predictive value 85.5%, negative predictive value 95.1%). Adnexal metastasis was correctly diagnosed in 8 of 11 cases in which it was present (sensitivity 72.7%, specificity 97.5%, positive predictive value 80%, negative predictive value 96.3%), and lymph-node metastasis in only 5 of 15 cases (sensitivity 33.3%, specificity 100%, positive predictive value 100%, negative predictive value 88.2%). CONCLUSION: These results suggest that 2D TAS and TVS evaluation of endometrial cancer are reliable methods for preoperative assessment of selected prognostic factors, e.g. myometrial invasion, cervical involvement and adnexal metastases. However in assessing lymph-node metastases, TVS with its low sensitivity, did not provide additional information. Preoperative ultrasound examination should be speculated as an important tool in the establishment of different surgical choices which can be made after a correct pretreatment prognosis.     

Role of magnetic resonance imaging and cause of pitfalls in detecting myometrial invasion and cervical involvement in endometrial cancer

Objective  To determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting myometrial invasion and cervical involvement in endometrial cancer. Study design  Seventy two consecutive patients with endometrial carcinoma underwent preoperative MRI. We compared the MRI results with the final histopathological findings. We classify myometrial invasion as <50 or ≥50% and cervical involvement as positive or negative. Standard statistical calculations were used. Results  The sensitivity, specificity, and accuracy of MRI for the detection of myometrial invasion ≥50% were 71, 86, and 58%, respectively. Positive and negative predictive values are 77 and 83%, respectively. The sensitivity, specificity, and accuracy of MRI for the detection of cervical invasion were 41, 97, and 46%, respectively. Positive and negative predictive values are 71 and 89%, respectively. The possible causes of misdiagnosis included a tumor isointense with the myometrium, polypoid tumor, myometrial thinning, exceedingly irregular myometrium, presence of adenomiosis, and presence of leiomyomas. Conclusion  MRI assists in planning the surgical treatment of endometrial cancer with an acceptable accuracy and a good specificity, although sensitivity is suboptimal.     

The accuracy of magnetic resonance imaging for preoperative deep myometrium assessment in endometrial cancer

ObjectiveTo evaluate the accuracy of preoperative magnetic resonance imaging (MRI) to detect deep myometrial invasion in patients with endometrial cancer.Materials and MethodsWe retrospectively reviewed 66 cases of women with endometrial cancer, who underwent preoperative MRI assessment and surgical staging between January 2006 and October 2010. The MRI findings were then compared with the pathology results. The diagnostic accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI in detecting deep myometrium invasion were evaluated.ResultsThe sensitivity, specificity, accuracy, PPV, and NPV results of MRI for the detection of deep myometrium invasion were 92.52%, 74.35%, 81.81%,71.42%, and 93.54%, respectively, with a kappa of 0.64. In the postmenopausal group, the values were 100%, 55.5%, 74.19%, 61.9%, and 100%. In the premenopausal women, they improved to 85.7%, 90.47%, 88.57%, 88.71%, and 90.47%. The sensitivity (100%) was better than the specificity (55.56%) in the postmenopausal women. The predictive value was markedly higher in the premenopausal women than the postmenopausal women (85.7% vs. 61.9%).ConclusionIn patients with endometrial cancer, a preoperative MRI contributes to accurate staging, allowing planning for the scale of surgery and preoperative counseling. In our study, the pretreatment identification of myometrium invasion provided the opportunity for small-scale surgery in the premenopausal women with early endometrial cancer. However, for the postmenopausal patients, the standard surgical procedure is indicated even if the degree of myometrium invasion is low.     

Magnetic resonance imaging for assessment of deep endometrial invasion for patients with endometrial carcinoma

Aims: To evaluate the value of magnetic resonance imaging (MRI) for the detection of deep myometrial invasion.
Methods: The patient group consisted of 53 women with endometrial cancer who underwent preoperative workup, including MRI, and surgical staging between August 1999 and August 2008 at Korea University Medical Center, Seoul, South Korea. The pathological data from surgical staging were compared with the preoperative MRI results.
Results: The mean age of the patients was 51 years and most patients had endometrioid cancer. On pathological evaluation of the myometrium, 20.8% had a deep myometrial invasion. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of MRI in detecting deep myometrial invasion were 50.0%, 89.7%, 79.2%, 63.6% and 83.3%, respectively. Evaluation of MRI findings and tumour grades by preoperative biopsy had a sensitivity and specificity of 88.9% and 87.5%, respectively, with a kappa of 0.764.
Conclusion: In patients with endometrial cancer, MRI is limited in its ability to detect deep myometrial invasion. The combination of MRI findings and tumour histology or grade can be helpful in determining if lymphadenectomy is necessary.     

Role of X-ray computed tomography in the staging of cervical carcinoma

X-ray computed tomography (CT) was performed in 132 cases of untreated cervical carcinoma, and the CT findings were compared with operative findings and pathological specimens in surgically treated cases, and with post-therapeutic CT findings in irradiated cases. The results were as follows: 1) The cervical image was significantly (p less than 0.01) enlarged in the group in which the diameter of the cancer in the specimen was greater than 2.0 cm. Accordingly, a cervical area exceeding 12.6 cm2 was classified as enlargement of the cervix. 2) With respect to parametrial invasion in surgically proven cases (176 parametrial), the diagnostic value of CT was indicated by a sensitivity of 58%, a specificity of 90%, and an accuracy of 83%. 3) In detecting paravaginal and vesical involvement, CT was superior to conventional diagnostic methods, and the accuracy of CT in the detection of vesical involvement was 96% in surgically treated cases. 4) The diagnostic value of CT in evaluating lymph node metastases in surgically confirmed cases was indicated by a specificity of 100%, and an accuracy of 88%; although the sensitivity was only 29%, when lymph node images with a maximum diameter exceeding 2.0 cm were regarded as metastases. The above findings indicate that CT provides greater accuracy in the staging of cervical carcinoma, when used with conventional methods.     

The diagnostic accuracy of magnetic resonance imaging in detecting cervical involvement in endometrial cancer

OBJECTIVES: The objective of this study was to determine the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting cervical involvement by endometrial cancer. METHODS: A retrospective accuracy study of 135 consecutive women who underwent preoperative MRI and surgery for endometrial cancer at a single gynaecological cancer centre between 1st February 2003 and 30th November 2004. RESULTS: For the detection of any cervical involvement by MRI, the sensitivity was 72%, specificity 93.2%, positive predictive value (PPV) 89.8%, negative predictive value (NPV) 80.2%, positive likelihood ratio (+LR) 10.7 and negative likelihood ratio (-LR) 0.3. When cervical stromal invasion was considered alone, the sensitivity was 84.4%, specificity 87.4%, PPV 67.5%, NPV 94.7%, +LR 6.7 and -LR 0.18. CONCLUSION: We believe that MRI is able to accurately predict cervical involvement in endometrial cancer and allows a decision to be made on the type of hysterectomy to be offered.